Recent MedPAC & MACPAC Activity

Feb 7, 2023 | Medicaid, Medicare, MedPAC

MedPAC: Assessing payment adequacy and updating mandated reports for Congress. MACPAC: Publishing reports on transition of coverage post-PHE, Medicaid managed care, nursing facility payment data, and drug coverage. Click to read more.

Managed Care Friday

Feb 3, 2023 | Managed Care Friday

40: The percent of parents who said they are “extremely or very worried” that their children are experiencing mental health issues like depression or anxiety, according to a new Pew Research Center study. Social media influences have been the #1 driver in research we've done, and the US Surgeon General recently stated that 13-year-olds are too young to join social media platforms. Solutions to help teens manage are increasingly centered around physical education in schools, whereas treatment for crisis continues to evolve. US Acute Care Solutions has partnered with Array Behavioral Care to...

Weekly Medicaid Update

Feb 1, 2023 | Medicaid

The brief highlights recent Medicaid policy developments in key states over the past week, including, but not limited to: NM: Medicaid agency cancels current MCO procurement process​ OH: Governor's budget proposes mental health spending increases​ UT: Bill to expand Medicaid dental benefits to all adults 21+ advances to the House Click to read more. 

BRG Quarterly Compliance Developments

Jan 31, 2023 | BRG Publications

The BRG Healthcare Transactions and Strategy quarterly compliance bulletin compiles noteworthy developments in the healthcare sector related to compliance, program integrity, and enforcement activities. In the fourth quarter of 2022, we have taken note of: DOJ/HHS Activity OIG Report on Medicare Part B Lab Spending OIG Workplans Two Comparative Billing Reports One Proposed Addition to RAC Audit List One GAO Report OCR Activity Click to read more. 

Managed Care Friday

Jan 27, 2023 | Managed Care Friday

38: The percentage of Americans who delayed healthcare treatment due to costs in 2022, a 12% increase compared to 2020 and 2021, according to a recent survey by Gallop. More than a quarter of those said the care they skipped was for “very” or “somewhat” serious conditions. Lower-income people, younger adults and women were more likely to delay care. In our own poll, nearly 75% of college age to 28-year-old males tend to skip care, not due to cost but due to fear. Fertile Ground: About one-third of infertility cases are caused by male reproductive issues, according to a study by the NIH....

2023 Value-Based Care Evolution

Jan 26, 2023 | BRG Publications

Value-based care (VBC) has been one of the most recognizable healthcare buzzwords of the past decade, with government, commercial payers, and industry stakeholders investing in developing more value-based arrangements (VBAs) that link payment to performance. Both providers and payers expect these VBAs to increase, although perceptions of where we are in this trend differ. In this paper, we provide a snapshot of spending trends, a primer on the spectrum of value-based arrangements, and guidance on successful negotiation. Click to read more.

Weekly Medicaid Update

Jan 25, 2023 | Medicaid

The brief highlights recent Medicaid policy developments in key states over the past week, including, but not limited to: MN: Governor's proposed budget includes increased rates for waiver services​ NC: Proposes policy to cover autism treatment for adults​ WA: Begins distributing behavioral health provider relief funds Click to read more. 

Significant ACO Reforms Finalized

Jan 24, 2023 | Medicare

CMS has finalized significant reforms to the Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs). In general, the policy changes ease the difficulty of remaining in the ACO program. ACOs will face less-difficult benchmarks and will be able to maintain one-side risk for longer periods. Click to read more. 

Managed Care Friday

Jan 20, 2023 | Managed Care Friday

28: Amount of market share on average that commercial payers say you probably need to have a fighting chance at leverage in reimbursement rate negotiations. The number varies by sub-sector and service and definitely geography. More recently payers are trying to hold the line on increasing rates, only allowing them if you are performing well, particularly around where you refer and how you treat. For instance, an OBGYN practice in the South has a high postpartum care and colorectal screening rate – 95% better than everyone else – and credentials all of its mid-levels with the payers, a...

Weekly Medicaid Update

Jan 18, 2023 | Medicaid

The brief highlights recent Medicaid policy developments in key states over the past week, including, but not limited to: ME: Implements rate increases for day health services and more​ NM: Gov. Grisham releases FY2024 budget proposal with Medicaid increases​ WI: Issues telehealth policy information Click to read more.